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Research Week 2017: Kids will be kids. But, why?

Sarah Feldstein Ewing’s innovative use of brain imaging identifies ways to treat adolescent risk behaviors
Research Week: Sarah Feldstein Ewing, Ph.D.
Using neuroimaging, Sarah Feldstein Ewing, Ph.D. (right) is researching ways to improve treatment approaches tailored specifically for teens by analyzing how adolescent brains respond to therapist language. (OHSU/Kristyna Wentz-Graff)

Sarah Feldstein Ewing, Ph.D., has been drawn to misguided and high-risk youth for most of her life. As an undergraduate, she worked in a group home for foster kids and served as foster care and juvenile justice liaison at New York’s Vera Institute of Justice, where she helped kids return to their foster programs following an arrest. She also worked with homeless youth in Africa, Equatorial Guinea, Ghana and Mali.

Her life experiences, an interest in the human brain, and social justice works such as Jonathan Kozol’s Amazing Grace, inspired Feldstein Ewing’s current research focus.

“I’m mystified as to why we aren’t able to get some high-risk kids back on track,” she said. “It motivates me to figure out what pulls kids into a particular domain of risk, as well as what kids possess – inside themselves - that somehow make them resilient to it.”

Following this inspiration, Feldstein Ewing embarked on three large-scale National-Institutes of Health-funded studies of more than1,000 adolescents in New Mexico, ranging from general community members to those who had recently been arrested. This work aims to answer these questions: What can we learn from the kids who do not get into trouble, and how can we apply that knowledge to inform and protect those who do?

Throughout the research process, Feldstein Ewing identified multiple gaps within available treatment regimens – empirically supported treatment and prevention options -- for adolescent addiction and HIV/AIDS risk prevention.

“They just haven’t been as effective as we need them to be,” she noted. “Although these teenage patients were receptive to the treatments, and showed some signs of progress, their overall behavior didn’t change as much as we would have expected when compared to the results of adults in the same programs.”

Research Week: Sarah Feldstein Ewing, Ph.D.
Feldstein Ewing's research includes recording 3-D brain images as adolescents hear and see statements from different age-appropriate treatments, including motivational interviewing and mindfulness. (OHSU/Kristyna Wentz-Graff)

This is when Feldstein Ewing turned to the brain as a way to better understand what was happening, not only with adolescent resilience but also with the response to different therapy techniques.

“The development of the brain takes many years,” she said, noting that the frontal cortex – or, the ‘behavioral brake’ component of the brain responsible for control – does not fully develop until age 25. “Understanding this, it seems unwise to apply treatments tailored to adult brains for youth who do not have all of those brain resources online yet.”

Today, as a professor of psychiatry (child and adolescent psychiatry) in the OHSU School of Medicine and director of the Adolescent Behavioral Health Clinic at OHSU Doernbecher Children’s Hospital, Feldstein Ewing’s goal is to improve treatment approaches tailored to adolescent brains. Her lab utilizes neuroimaging techniques to study how adolescent brains respond to therapist language. This work, funded by the National Institutes of Alcohol Abuse and Alcoholism of the NIH, records and reviews 3-D imagery of young brains as they hear and see statements from different age-appropriate treatments, including motivational interviewing and mindfulness. The results, Feldstein Ewing expects, will pave the path for the development of new, novel and relevant therapies that work more effectively for teens.

“The treatments we have today are valuable, as they provide us useful data. However, sometimes it is more important to step away from historical findings and start anew,” she said. “This is the direction I think we need to look in order to help kids make healthy decisions.”

Feldstein Ewing expects initial study results to be available in summer 2018.

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